Patient-specific implant (PSI) osteosynthesis plates are popular in modern orthognathic surgery (Arcas et al., 2018; Hanafy et al., 2019; Heufelder et al., 2017; Kim et al., 2019; Kotaniemi et al., 2019; Li et al., 2017; Lin et al., 2018; Suojanen et al., 2016). Reported advantages of PSI plates include increased predictability of outcomes, less invasive procedures, and shorter operation times (Arcas et al., 2018; Hanafy et al., 2019; Heufelder et al., 2017; Kim et al., 2019; Li et al., 2017; Suojanen et al., 2016; Van den Bempt et al., 2018). However, this strategy relies solely on presurgical virtual 3D planning, without considering difficulties that may arise during surgery, necessitating deviation from the original plan. With PSI osteosynthesis plates, the position of the bony segments cannot be adjusted intra-operatively according to individual differences in lip-to-incisor ratios or to improve interdigitation of the dental cusps. Furthermore, it is unclear who is responsible for the pre-operative 3D planning in studies of PSI osteosynthesis plates: is it the surgeon, the clinical engineer, or possibly the trainee? Preoperative 3D planning gives the operator false assurance that everything will proceed exactly according to the provided plan; however, it does not discharge the surgeon from being responsible for the final surgical result. Reported accuracy of PSI plates (definitive position compared to the virtual planned position) is good, ranging from 0.0 to 2.02 mm, with maximal overcorrection of 1.74 mm and maximal undercorrection of −2.02 mm (Hanafy et al., 2019; Heufelder et al., 2017; Kim et al., 2019). However, what is the advantage of a fairly (?) accurate repositioning when the segment is guided to a wrong position and cannot be adjusted? Maxillary impaction is often related to smile aesthetics; occlusal cant and midline can be determined with virtual design software, but average lip-to-incisor ratios vary between 28% and 100% (Olate et al., 2016). If one considers the standard deviations, it is obvious that the planned vertical position of the maxilla often requires alteration intraoperatively, which has consequences for the position of the mandible and the necessity or magnitude of chin advancement osteotomy.
https://www.sciencedirect.com/science/article/pii/S1010518220302389
Third-generation slotplates for orthognathic and facial corrective surgery
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